Medicare/Medicaid EHR Incentive Program
In general, you will be considered a meaningful EHR user during an EHR reporting period in a payment year if you use certified EHR technology to capture, exchange and report specific information/quality measures.
Part of qualifying for EHR incentives involves the use of technology that is certified by the U.S. Department of Health and Human Services (HHS). HHS included both complete EHR systems and EHR modules in its definition of certified technology, meaning you can: (1) purchase a comprehensive certified package from a single vendor or (2) purchase certified components from different vendors. If you are already using an EHR or a module(s) and are unclear whether it is or will be certified for use under the Medicare / Medicaid EHR Incentive Program (often referred to as the "Meaningful Use Program"), ask your vendor what their plans are. Also, if your vendor indicates they are certified, verify this by visiting the website for the Office of the National Coordinator for Health IT, the federal agency within HHS that is charged with certifying EHRs.
Visit the Office of the National Coordinator for Health Information Technology (ONC) website for more on certification specifics. Also see the final rule on the standards, specifications and certification criteria for EHR technology, issued July 13, 2010, by HHS/ONC for Stage 1 of the EHR Meaningful Use Incentive Program. Final certification standards for Stage 2 are forthcoming. More information about the various "Stages" of the Program can be found below.
The CMS outlined meaningful use in three stages. Note that only Stage 1 criteria, for use in years 2011 and 2012, have been finalized. Meaningful use criteria for Stages 2 and 3 will be defined in future rules, and is expected to become progressively more stringent. Also note that the CMS, the federal agency who administers the Incentive Program, is expected to extend Stage 1 to 2014 for those physicians and other eligible professionals who met the EHR Meaningful Use Incentive requirements in 2011.
NOTE: The CMS expects physicians to meet meaningful use measures for all patients seen during the reporting period—including both Medicare and non-Medicare patients and private payer non-Medicare/Medicaid patients—in order to qualify for Medicare/Medicaid EHR incentives. The AMA believes that the law only requires accomplishing measures for Medicare (or Medicaid) patients seen/provided services for during the reporting period and does NOT include private payer non-Medicare/Medicaid patients. While the AMA continues to pursue this point with CMS, it is important for physicians to know that CMS expects physicians to meet the meaningful use measures for all patients seen during the reporting period in order to qualify for Medicare/Medicaid EHR incentives.
Following substantial input from the AMA and other stakeholders, CMS published the final requirements physicians and hospitals will need to meet to receive these incentives. The final rule for Stage 1 was published in the Federal Register. Learn more about what requirements must be met for Stage 1.
The AMA has developed a series of short fact sheets and frequently asked questions which provide a brief overview of the requirements for Stage 1, found below.
The requirements for Stage 2 are final. The AMA has summarized CMS' final requirements for Stage 2, and prepared a table tracking the final requirements.
CMS has created a toolkit to help understand how to meet the Stage 2 requirements.
There are numerous online resources available to physicians interested in becoming a "meaningful user" of an EHR, many of which are listed below under "Additional Resources." In addition, the federal government is funding entities known as "Regional extension centers" (RECs) which are aimed at helping primary care physicians select and adopt a certified EHR. Locate your REC using the AMA's interactive map or by visiting ONC’s REC webpage. Also, see this facts-at-a-glance document on the RECs.
The AMA continues to advocate strongly for making the EHR Meaningful Use Incentive Program more workable for physicians by asking CMS to establish more reasonable reporting requirements, measurement thresholds, and overall flexibility so that all physicians who want to participate are able to do so. Below are links to all of the AMA’s letters and testimony. As a result of significant AMA advocacy, CMS made several changes to the Stage 1 requirements reducing the number of overall requirements and including exceptions to certain measures.
AMA Chair Steven J. Stack, MD testifies before CMS on EHR Meaningful Use, May 3, 2013
February 1, 2013 comment letter to ONC on HIT Policy Committee's Patient Safety Action and Surveillance Plan
January 2013 comment letter to ONC on HIT Policy Committee's Proposed Stage 3 Meaningful Use criteria
May 2012 sign-on letter to CMS on Proposed Stage 2 Meaningful Use Rule
May 2012 comment letter to ONC on Proposed Stage 2 Certification Rule
March 2012 health IT and patient safety letter to ONC.
June 2011 Sign-on letter to HHS on Stage 1 and Stage 2 MU measures, accompanied by a matrix illustrating applicability to different specialties of Stage 1 and proposed Stage 2 Meaningful Use requirements, and a color-coded dashboard depicting overall ability of several specialties to meet EHR Incentive Program requirements.
April 21, 2011 statement to ONC HIT Policy Committee on usability of EHRs
February 2011 sign-on letter on proposed requirements for Stage 2 meaningful use of EHRs
January 27, 2011 letter to CMS opposing application of Meaningful Use requirements to private pay patients and March 10, 2011 response from CMS
June 2011 cross-industry letter to HHS on EHR Incentive Program
July 2010 press release on Stage 1
March 2010 letter to CMS on Stage 1 proposed rule signed by several state and specialty medical societies
August 2009 letter and attached matrix to CMS and ONC in reaction to the Health IT Policy Committee’s proposal on meaningful use
August 2009 letter to HHS on meaningful use
September 2009 letter AMA signed onto concerning lack of sufficient quality measures for specialists
The AMA has received a number of complaints and concerns associated with physicians undergoing an audit for receipt of the Meaningful Use (MU) of Electronic Health Records (EHRs) Incentive program including requests for information to support attestation which difficult to produce (i.e. screen shots showing a requirement was met since some products cannot do this), requests for information that physicians were never informed they needed to retain, extremely short response times to furnish information to the MU audit contractor, and physician who have received both pre-payment and post-payment audits. Presently between 5% to 10% of "eligible professionals" (which includes physicians) are being targeted for a Meaningful Use audit. The AMA has communicated these concerns to CMS and they are exploring our concerns in greater depth. Should a physician come across any of these problems they are urged to communicate this to the MU audit contractor (i.e. ask for more time to comply, indicate any documents they are unable to furnish). CMS has also said it was not their intention to target the same physician for both a post-pay and pre-pay audit. Physicians who have encountered this problem are encouraged to contact the contractor as well. The contact information for the MU audit contractor can be found below:
Figliozzi & Company, CPAs P.C.
585 Stewart Avenue
Garden City, NY 11530
(516) 745-6400 ext. 302
Overview of American Recovery and Reinvestment Act
Brochure on EHR Incentive Programs
CMS webpage on EHR Incentive Program including information on how to register and attest for the EHR Incentive Program
AHRQ Guide to Reducing Unintended Consequences of Electronic Health Records
AMA resources on HIPAA Privacy
AMA resources on HIPAA Security>
AMA resources on Health Information Exchange